Provider Demographics
NPI:1003198698
Name:SHETH, ASHVIN O (MSW)
Entity Type:Individual
Prefix:
First Name:ASHVIN
Middle Name:O
Last Name:SHETH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 CORDELE ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4562
Mailing Address - Country:US
Mailing Address - Phone:219-762-3419
Mailing Address - Fax:
Practice Address - Street 1:3007 CORDELE ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4562
Practice Address - Country:US
Practice Address - Phone:219-762-3419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000336A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical